Deployment handle for a pre-loaded iliac prosthesis delivery device

ABSTRACT

A delivery system for delivering an endovascular prosthesis is disclosed. A handle assembly is disposed at the distal end of the delivery system. The handle assembly includes a main handle and a second handle disposed at least partially on the main handle and rotationally moveable relative to the main handle. A trigger wire release mechanism is operatively coupled to the second handle. A sheath is operatively coupled to the second handle, such that rotation of the second handle relative to the main handle retracts the sheath in a distal direction. Rotation of the handle also moves the trigger wire release mechanism from a first position to a second position to retract one or more trigger wires.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser.No. 15/156,959, filed May 17, 2016, which claims the benefit of U.S.Provisional application Ser. No. 62/164,184, filed May 20, 2015, both ofwhich are incorporated by reference herein in their entireties.

BACKGROUND

This invention relates generally to medical devices and methods of usingthe same, and more particularly, to an endovascular prosthesis deliverydevice and methods for placement and deployment of the prosthesis in thelumen of a vessel.

Endovascular prostheses, such as a stent, stent-graft, vena cava filteror occlusion device, may be inserted into an anatomical vessel or ductfor various purposes. For example, a stent graft may be deliveredintraluminally from the femoral artery for treatment of vasculature inthe human or animal body to bypass a repair or defect in the vasculatureor to maintain or restore patency in a formerly blocked or constrictedpassageway. The stent graft may extend proximally and/or distally awayfrom a vascular defect, including a diseased portion of an aneurysm, andengage a healthy portion of a vessel wall.

In many cases, the damaged or defective portion of the vasculature mayinclude a branched or side vessel such as a common iliac artery and/oran internal iliac artery and external iliac artery extending from thecommon iliac artery. Commonly, to repair a defect in these branchedvessels, a stent graft is provided which, when deployed in the commoniliac artery, has a side arm or fenestration positioned towards theopening to the internal iliac artery. If desired, an extension stentgraft can be deployed through the side arm or fenestration into theinternal iliac artery to bypass a diseased portion thereof and restorethe blood flow path to the internal iliac artery.

The stent graft to be implanted may be coupled to a delivery device in acompressed state and then released from the delivery device so as toexpand within the vessel. The delivery device may then be withdrawn,leaving the stent graft in position within the vessel. Oftentimes, thesteps to carry out the deployment of the stent graft may occur in apre-determined deployment sequence. For example, the delivery device mayfirst be positioned within the vessel, then the sheath retracted toallow the stent graft to at least partially expand. Further steps maythen be performed, for example, that facilitate release of one or bothends of the stent graft, to deploy an anchoring stent, and the like. Inmost cases, it is desirable that such deployment steps follow a specificorder as instructed by the manufacturer of the device. The deliverydevice described herein comprises a handle assembly that permitscontrolled and sequential release and deployment of a stent graft fromthe delivery device.

While this invention will be generally discussed in relation to adelivery device for a stent graft and method of deployment thereof intoa common iliac artery and/or into an internal iliac artery, it is alsocontemplated that the invention is not so limited and may relate to anybody or vessel lumen in which such a deployment is necessary or desired.

SUMMARY

The present disclosure provides a handle assembly and a delivery systemfor delivering and deploying an endovascular graft into one or morebranched vessels.

In one example, a handle assembly for a prosthesis delivery device isdisclosed. The handle assembly comprises a main handle comprising aproximal end and a distal end and sidewall extending there between todefine a main handle housing interior. A second handle is disposed atleast partially on the main handle and is longitudinally moveablerelative to the main handle. A trigger wire release mechanism isdisposed in the main handle housing interior and wherein at least oneproximal trigger wire extends from the trigger wire release mechanism toa proximal end of a prosthesis and wherein at least one distal triggerwire extends from the trigger wire release mechanism to a distal end ofthe prosthesis. Longitudinal movement of the second handle relative tothe main handle causes retraction of the trigger wire release mechanismwithin the main handle housing interior, thereby releasing the at leastone proximal trigger wire from the proximal end of the prosthesis andreleasing the at least one distal trigger wire from the distal end ofthe prosthesis.

In another example, a delivery system for delivering a prosthesis isdisclosed. The delivery system comprises a proximal end and a distalend. A prosthesis retention region is located at the proximal end of thedelivery system. A prosthesis is releasably coupled to the prosthesisretention region of the delivery system. The prosthesis comprises aproximal end and a distal end and a sidewall extending there between,and a side arm extending from the sidewall of the prosthesis between theproximal and distal ends. A handle assembly is disposed at the distalend of the delivery device. In one example, the handle assemblycomprises a main handle comprising a proximal end and a distal end andsidewall extending there between to define a main handle housinginterior. A second handle is disposed at least partially on the mainhandle and longitudinally moveable relative to the main handle. Atrigger wire release mechanism is disposed in the main handle housinginterior, the trigger wire release mechanism having a first positionwithin the main handle housing in which the prosthesis is retained in adelivery configuration and a second position in which the prosthesis isin a deployed configuration. A sheath is operatively connected to thesecond handle and extends proximally of the main handle, the sheathhaving a first position wherein the prosthesis is covered by the sheathand a second position, and wherein longitudinal movement of the secondhandle relative to the main handle retracts the sheath in a distaldirection from the first position to the second position. Movement ofthe trigger wire release mechanism from the first position to the seconddeployed position is prevented when the sheath is in the first position.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of a prosthesis delivery device with an example ofa handle assembly at the distal end and a prosthesis retained beneath asheath at the proximal end.

FIG. 2 is a rear perspective view of the delivery device of FIG. 1.

FIG. 3 is an exemplary stent graft that may be delivered and deployedwithin the vasculature of a patient.

FIG. 4 is another exemplary stent graft that may be delivered anddeployed within the vasculature of a patient.

FIG. 5 illustrates one example of a stent graft releasably coupled tothe proximal end of the delivery device and a catheter extending throughthe stent graft.

FIG. 6 is an enlarged view of a portion of FIG. 5.

FIG. 7 is a front perspective view of a sheath connector component ofthe handle assembly.

FIG. 8 is a rear perspective view of the handle assembly.

FIG. 9 is a side cross-sectional view of the handle assembly.

FIG. 10 is a rear perspective view of a portion of the main handle ofthe handle assembly.

FIG. 11 is a front perspective enlarged view of a portion of the mainhandle of the handle assembly.

FIG. 12 is an exploded cross-sectional view of the outer rotating secondhandle and end cap.

FIG. 13 is a perspective view of the handle assembly with a portion ofthe second handle removed.

FIG. 14 is a perspective view of the handle assembly with the secondhandle moved distally relative to the main handle to at least partiallyretract the sheath.

FIG. 15 is an enlarged perspective view of the handle assembly with aportion of the second handle removed.

FIG. 16 is a perspective view of one example of a nut mechanism of thehandle assembly.

FIG. 17 is a rear perspective cross-sectional view of the distal end ofthe handle assembly.

FIG. 18 is a side cross-sectional view of a catheter extending throughone example of a catheter hub.

FIG. 19 is a partial cross-sectional side view of the sheath extendingproximally to cover the catheter and at least a distal end of the nosecone.

FIG. 20 illustrates the sheath retracted from the distal end of the nosecone to expose a proximal end of the catheter.

FIG. 21 is a perspective view of the handle assembly after the sheathhas been at least partially retracted by moving the second handledistally relative to the main handle.

FIG. 22 is a perspective view of the handle assembly of FIG. 21 with aportion of the second handle and outer ring removed to illustrate thesleeve in a distal position and the nut disengaged from the main handle.

FIG. 23 is a perspective view of the handle assembly with the secondhandle fully retracted relative to the main handle.

FIG. 24 is a perspective view of the handle assembly of FIG. 23 with aportion of the second handle and outer ring removed to illustrate thesleeve in a distal position and the nut disengaged from the main handle.

FIG. 25 is an enlarged partial sectional view of one example of a distalend of the handle assembly.

FIG. 26 is an enlarged side cross-sectional view of the handle assemblyillustrating the trigger wires extending proximally from the triggerwire knob, through the conduit provided by the expanded spring and intothe lumen of the positioner.

FIG. 27 illustrates the second handle moved distally towards the triggerwire knob to compress the spring.

FIG. 28 illustrates one example of a trigger wire releasably coupled tothe distal end of a stent graft.

FIG. 29 illustrates another example of a trigger wire releasably coupledto the distal end of a stent graft.

FIG. 30 illustrates yet another example of a trigger wire releasablycoupled to the distal end of a stent graft.

FIG. 31 is a side view of one example of a nut and a sleeve in aproximal position retaining the nut into engagement with the mainhandle.

FIG. 32 is a perspective view of one example of a sleeve.

FIG. 33 is a side view of one example of a nut with the sleeve moveddistally causing the nut to flare radially outwardly and disengage fromthe main handle.

FIG. 34 illustrates the delivery device of FIG. 1 being tracked to adesired location within a patient's vasculature during delivery anddeployment of a stent graft.

FIG. 35 is an enlarged view of a portion of the device of FIG. 34illustrating a sheath extending to the nose cone and a pre-loadedcatheter and guide wire extending proximally through the sheath andbeyond the proximal end of a sheath.

FIG. 36 is an enlarged view of FIG. 35 illustrating the proximal tip ofthe pre-loaded catheter and guide wire extending beyond the proximal endof the sheath.

FIG. 37 illustrates the delivery device in the vasculature and the guidewire being snared from the contralateral iliac artery.

FIG. 38 is an enlarged view of FIG. 37 showing the guide wire beingsnared from the contralateral side to create a “through and through”wire.

FIG. 39 illustrates an access sheath being tracked proximally over theguide wire.

FIG. 40 illustrates the initiation of distal retraction of the sheathand the access sheath removed.

FIG. 41 illustrates the sheath retracted to expose the proximal end andside arm of the stent graft.

FIG. 42 illustrates an up and over sheath being tracked proximallythrough the contralateral iliac artery over the guide wire.

FIG. 43 illustrates the up and over sheath of FIG. 42 being tracked overthe aortic bifurcation and then distally into the proximal end of thestent graft.

FIG. 44 illustrates a secondary delivery assembly being tracked throughthe up and over sheath and into the side arm of the stent graft towardsto opening of the internal iliac artery.

FIG. 45 illustrates an enlarged portion of FIG. 44.

FIG. 46 illustrates a secondary stent graft being introduced into theinternal iliac artery.

FIG. 47 illustrates an enlarged portion of FIG. 46.

FIG. 48 illustrates the delivery device within a patient's vasculaturewith the sheath further retracted to expose the distal end of the stentgraft.

FIG. 49 illustrates the stent graft and secondary stent graft deployedwithin the patient's vasculature.

FIG. 50 is a perspective view of the delivery device with the sheathfully retracted and the stent graft deployed therefrom.

FIG. 51 is a perspective view of the delivery device with the secondhandle moved proximally with the proximal tip re-sheathed and configuredfor withdrawal of the device from a patient.

DETAILED DESCRIPTION

In this description, when referring to a prosthesis delivery device,proximal refers to the part of the delivery device that is furthest fromthe operator and intended for insertion in a patient's body and distalrefers to that part of the delivery device closest to the operator. Withregard to the prosthesis, the term proximal refers to that part of theprosthesis that is closest to the proximal end of the delivery deviceand distal refers to the opposite end of the prosthesis. The term“ipsilateral” is used to indicate that the diseased vessel(s) beingaccessed during a given procedure are on the same side of the body(right or left) as the vascular access delivery device/introducer, while“contralateral” signifies that the vessel(s) of interest are on theopposite side of the body.

In general and described in more detail below with reference to thereference numbers and Figures, the delivery device 2 includes a proximalend 4 and a distal end 6. A handle assembly 8 is located adjacent thedistal end of the device. One example of a handle assembly 8 isdescribed in detail below and also described in U.S. Provisional patentapplication 62/074,766 filed Nov. 4, 2014, entitled “Deployment HandleFor A Prosthesis Delivery Device”, and U.S. Provisional patentapplication 62/097,244 filed Dec. 29, 2014, entitled Deployment HandleFor A Delivery Device With Mechanism For Quick Release Of A ProsthesisAnd Re-Sheathing Of Device Tip,” which applications are incorporated byreference herein in their entireties. Handle assembly 8 generallyincludes first or main handle 10 and a second or outer handle 12 and anend cap 14. The main handle 10 is fixed relative to the delivery device2 and the second handle 12 is disposed on the main handle 10 and ismovable longitudinally and/or circumferentially relative to the mainhandle.

A mechanism within the handle assembly 8 permits the user to implement a“quick release” deployment procedure in which at least a distal portionof a prosthesis can be easily and quickly released from the deliverydevice 2 and deployed within the patient's vasculature if necessaryand/or desired. When deployment of the prosthesis is complete, this samequick release mechanism within the handle assembly 8 may also facilitatere-sheathing or “hubbing” of the proximal end of the delivery device 2,to facilitate removal of the delivery device from the patient's tortiousvasculature.

As shown in FIGS. 1 and 2, the proximal end 4 of the delivery device 2includes stent graft retention region 16 and a tapered nose cone dilator18 having a proximal tip 20. An inner cannula 22 extends thelongitudinal length of the delivery device 2, from a distal flush hub 24at the distal end 6 of the device 2 to the tapered nose cone dilator 18at the proximal end 4 of the device 2. Inner cannula 22 has an innerlumen 26 which may accommodate a guide wire 28 for tracking the deliverydevice 2 to a desired position within a patient's vasculature and whichmay be used for flushing or injection of fluids. The inner cannula 22may be made of a variety of suitable materials including a flexiblematerial, polymer, metal and/or alloy, for example, nitinol or stainlesssteel, and may be either straight or have a curve imparted to a portionof it.

A stiffening cannula, sometimes referred to as a pusher or positioner 30may be disposed over at least a portion of the inner cannula 22. Thepositioner 30 may be constructed from various materials, and in oneexample, a proximal portion 32 of the positioner which is introducedinto the patient may comprise a polymer, sometimes referred to as VRDT(or vinyl radiopaque dilator tubing), plastics, metals, alloys or acombination thereof, whereas a distal portion 34 of the positioner 30may comprise the same material as the proximal portion 32 of thepositioner 30 or it may be a different material including but notlimited to plastics, polymers, alloys, metals or a combination thereof,that provide sufficient maneuverability and stiffness to the positioner30 as necessary and desired. The positioner 30 may extend from alocation just distal of the stent-graft retention region 16 coaxial witha length of the inner cannula 22, through the main handle 10, andterminate at a distal end 34 within a stationary collar 36 within themain handle 10. The positioner 30 may be retained within the stationarycollar 36 by various means, including threaded attachment, adhesives,welding, and/or other suitable attachment mechanism. For a length of thepositioner 30, a stiffening rod (not shown) may be disposed over theinner cannula 22 and/or over the positioner 30 for additional stabilityand maneuverability.

Referring now to FIGS. 3 and 4, at least two exemplary stent grafts 42are shown, which may be deployed in a controlled and sequential mannerusing the delivery device 2 described herein. The stent graft 42 iscarried on the inner cannula 22 at the stent-graft retention region 16as shown in FIGS. 1 and 2. The stent-graft 42 has a proximal end 44, adistal end 48, and a series of stents 50 extending the length of thestent graft 42 and attached to the graft material 52.

The proximal end 44 of the stent graft may include a sealing stent 56.Sealing stent 56 may be internal or external to the graft material 52. Aseries of body stents 50 also are attached to the graft material 52 andmay be sutured to the graft material or held to the graft material inother known ways. The series of body stents 50 may be internal orexternal to the graft material 52, or both. As shown in FIG. 3, all ofthe stents are external to the graft material 52, while in FIG. 4, thedistal-most stent 50 is internal to the graft material 52.

As shown in FIG. 3 and FIG. 4, the stent graft 42 may comprise a sidearm or limb 58 extending from the tubular main body 62. The side arm 58may be integrally formed with the main tubular body 62 and extend fromthe tubular main body 62 at bifurcation 70. Alternatively, the side arm58 may be separately formed and attached to the main tubular body, andin one example, the side arm 58 may extend from a fenestration 60 formedin the wall of the main tubular body 62 as shown in FIG. 3. The side arm58 may also include one or more stents 72 along its length, eitherinternal or external or both. Although FIGS. 3 and 4 show a stent graft42 having a single side arm 58 extending therefrom, the stent graft mayalso be a single non-bifurcated tube and/or the stent graft may have oneor more fenestrations formed in the graft material 52 and/or one or moreadditional side branches or arms extending therefrom. Radiopaque markers(not shown) may be placed on various parts of the stent graft 42 to aidin tracking and locating the device at a desired location during aprocedure and one or more barbs (not shown) may extend from any one ofthe body stents 50 or the sealing stent 56 to help anchor the stentgraft to the vessel wall.

An exemplary coupling of the stent graft 42 to the delivery device isshown in FIGS. 5 and 6. More specifically, FIGS. 5 and 6 illustrate aproximal end portion 4 of the delivery device 2, and one non-limitingexample of an attachment and release mechanism for the proximal end 44of a stent graft 42 that can be operated using the handle assembly 8described herein. FIGS. 5 and 6 show the tapered nose cone dilator 18having a proximal tip 20 and a reverse distal taper 78 at its distal end82. The surface of the nose cone dilator 18 presents a smooth taperedsurface 76 to facilitate entry into and movement through a body vessel.Nose cone dilator 18 may include radiopaque material or be equipped witha radiopaque marker (not shown) to facilitate visualization of the nosecone dilator 18 in use.

As shown in FIG. 6, an exemplary prosthesis attachment and retentionmechanism releasably couples the stent graft to the inner cannula 22. Ina non-limiting example, as shown in enlarged view in FIG. 6, theattachment and release mechanism comprises at least one trigger wire 84having a proximal end 86 and a distal end 88. However, other attachmentand release mechanisms, including an additional trigger wire 90 alsohaving a proximal end 86 may also be used to releasably couple theproximal end 44 of the stent graft 42 to the inner cannula 22. Otherattachment and release mechanisms, in addition to the one or moretrigger wires 84, 90 may also be used to couple the proximal end 44 ofthe stent graft 42 to the delivery device 2, such as diameter reducingties, a retractable sheath, sutures and the like as will be recognizedby one of skill in the art.

In one non-limiting example, the proximal trigger wires 84 and 90 mayextend from the handle assembly 8, within positioner 30, and along theouter surface 92 of the inner cannula 22 to the proximal end 44 of thestent graft. More particularly, the distal ends 88 of the proximaltrigger wires 84, 90 may be coupled to a trigger wire release mechanismor knob 204 located within the main handle interior 124, such as byadhesives, welding, crimping or by set screws 214 (as will be describedin further detail below in connection with FIG. 25). From the triggerwire knob 204, the proximal trigger wires 84, 90 extend proximally alongthe outer surface of the positioner 30 for a distance, then enter thelumen of the positioner 30 and extend proximally to the proximal end 44of the stent graft 42. The proximal ends 86 of the trigger wires 84, 90are releasably coupled to the proximal end 44 of the stent graft 42 asshown in FIG. 6.

In one example, the proximal trigger wires 84, 90 may be directly orindirectly attached to the proximal end 44 of the stent graft 42. Forexample, the proximal trigger wires 84, 90 may engage a suture loop (notshown) which is attached to the proximal end 44 of the stent-graft 42.In this way, the trigger wires may not weave directly through the graftmaterial 52. Alternatively, the proximal trigger wires 84, 90 may bewoven directly through or removably attached to the graft material 52 orwoven over or through one or more stents 50 and/or 56 at the proximalend of the graft 42. As FIG. 6 shows, the proximal trigger wires 84, 90are woven directly through the graft material 52 at the proximal end 44of the stent graft 42 at two spaced apart points around the periphery ofthe tubular graft body 62 such that when those points are retained bythe trigger wires against the inner cannula 22, the stent graft 42generally forms a “FIG. 8” formation with one lobe of the “FIG. 8” beingslightly larger than the other lobe of the “FIG. 8.” Of course, otherpoints of attachment may also be used to releasably couple the stentgraft 42 to the inner cannula 22 to form various configurations at theproximal end 44 of the stent graft 42. As FIG. 6 shows, the proximalends 86 of the trigger wires 84, 90 may be retained within the distalend of the nose cone, such as by friction fit or other suitableattachment means that allow for the trigger wires to be pulled distallyand released from the inner cannula when deployment of the proximal endof the stent graft 42 is necessary or desired. Other suitable attachmentmethods or mechanisms may be used to removably attach the proximaltrigger wires 84, 90 to the proximal end of the stent graft 42 as wouldbe recognized by one of skill in the art.

Upon retraction of the trigger wires 84, 90, the proximal end 44 of thestent graft 42 can at least partially deploy radially outwardly withinthe vessel. If other diameter reducing ties are being used to radiallyrestrain the proximal end 44 of the stent graft 42, those ties must alsobe removed to allow the proximal end 44 of the stent graft to fullydeploy from the inner cannula 22 within the vessel.

As shown in FIGS. 1, 5 and 6, a prosthesis, such as stent graft 42, isdisposed on the inner cannula 22 at the proximal end 4 of the deliverydevice 2 at stent graft retention region 16. The stent graft 42 has anuncoupled state in which the graft is positioned coaxially over theinner cannula 22 with the proximal end 44 of the stent graft 42 inlongitudinal proximity relative to the distal end 82 of the nose conedilator 18. During assembly, the proximal ends 86 of the trigger wires84, 90 can be woven directly through the graft material 52 at one ormore points at the proximal end 44 of the stent graft 42, oralternatively, the proximal ends 86 of the trigger wires 84, 90 may becoupled to one of the stents 50 and/or 56 at the proximal end 44 of thestent graft 42. In another example, the proximal ends 86 of the triggerwires 84, 90 can be woven through or around one or more suture loops(not shown) that are secured to the graft material 52 at or near theproximal end 44 of the stent graft to avoid weaving the trigger wires84, 90 directly through the graft material 52. After weaving through thestent graft 42 (or through one or more of the proximal stents 56, 50 orthrough one or more suture loops), the proximal ends 86 of the triggerwires 84, 90 may extend proximally into the nose cone, or alternatively,extend back into the inner cannula 22 through one or more apertures (notshown) formed in the inner cannula. The proximal ends 86 of the triggerwires 84, 90 may be releasably held in place, either within the nosecone or within the inner cannula lumen by friction fit or otherreleasable attachment mechanisms. When deployment of the stent graft isdesired, retraction of the trigger wires 84, 90 allows the proximal end44 of the stent graft 42 to move from a radially inwardly constraineddelivery configuration to a radially outwardly expanded configurationwithin a vessel, as described further below.

The coupling shown in FIG. 6 releasably secures the stent graft 42 tothe inner cannula 22 to radially inwardly restrain the stent graft 42 ina manner that may subsequently facilitate insertion of the subassemblycomprising the inner cannula 22 and the stent graft 42 into an outersheath 104, such as sheath 104 described below. As will be apparent, theouter sheath 104 is configured to radially restrain other regions of thestent graft 42 for delivery in a low-profile configuration to a targetsite within a patient's anatomy.

As shown in FIG. 1, the longitudinally slideable and retractable sheath104 extends along the length of the delivery device 2 from the mainhandle 10 to the nose cone dilator 18. The sheath 104 is configured tocover and assist in retaining a prosthesis, such as stent graft 42, in aradially inwardly compressed, low-profile configuration during deliveryof the prosthesis to a target site within a patient's anatomy. Thedistal end 106 of the sheath 104 is connected within the main handle 10by a sheath connector 108, which is shown in FIG. 7. In one example, thedistal end 106 of the sheath 104 may be slightly flared to facilitateattachment of the sheath 104 to a correspondingly shaped taperedproximal end 110 of the sheath connector 108 as shown in FIG. 7. Thedistal end 106 of the sheath 104 may be secured to the proximal end 110of the sheath connector 108 by a friction fit, threaded engagement,adhesives or other attachment mechanisms or combination thereof. Thesheath connector 108 has at least one lumen 112 extending from itsproximal end 110 to its distal end 114, which allows for sheathconnector 108 to travel or slide longitudinally along the positioner 30.The sheath connector 108 also includes a sheath flush port 116,comprising a one way valve that communicates with the sheath connectorlumen 112 to allow sheath flushing prior to introduction into thevasculature. An O-ring or silicone disc at the distal end of the sheathconnector lumen 112 and a seal within the sheath flush port 116 preventsunintended back flow or leakage of fluid through the sheath connector108 and flush port 116.

As shown generally in FIGS. 8 and 9, the handle assembly 8 includes afirst or main handle 10 and second or outer handle 12. The main handle10 is fixed relative to the delivery device 2. The second handle 12 isdisposed on at least a portion of the main handle 10 and is movablelongitudinally and/or circumferentially relative to the main handle 10.

The main handle 10 comprises a proximal end 118 and a distal end 120with an outer surface or side wall extending there between to form ahandle interior 124. As will be described below, the handle interior 124houses additional mechanical components that make up the handle assembly8. The main handle 10 may be injection molded as a single unitarystructure or alternatively, as shown in FIG. 10, the main handle 10 maycomprise upper and lower parts or first and second halves that clamshell, lock, snap-fit or are otherwise securable to each other.

The proximal end 118 of the main handle 10 may include a grippingportion 126 for a physician to grip with one hand while manipulating thesecond handle 12 (such as during sheath retraction during deployment).The gripping portion 126 of the main handle 10 is preferablyergonomically shaped for user comfort, and may be covered in a layer ofsofter plastic or rubber or have a gripping surface to ensure a stablegrip. As shown in FIG. 2, the gripping portion 126 is a proximal portionof the main handle that may have a greater diameter 128 than theremainder of the main handle 10 which has a reduced diameter portion 130and extends distally behind the gripping portion 126. It is the reduceddiameter portion 130 of the main handle 10 upon which the second handle12 can longitudinally move.

At least a portion of the outer surface 122 of the main handle 10includes partial or full threads 132 along its surface 122 as shown indetail in FIG. 11, which threads 132 extend distally from a locationjust distal of the gripping portion 126 to the handle end cap 14. Alongitudinal slot 134 having a proximal end 136 and a distal end 138 isformed along a portion of the length of the main handle 10, between thegripping portion 126 and the handle end cap 14. As shown in FIG. 8, thesecond handle 12 is located on the main handle 10. The second handle 12may be a generally tubular structure that extends at least partiallyaround the outer surface 122 of the main handle 10. The second handle 12may be injection molded as a single unitary structure or alternatively,as shown in FIG. 12 the second handle 12 may comprise upper and lowerparts or halves that clam shell, lock, snap-fit by snaps 141 or areotherwise securable to each other. The second handle 12 may furtherinclude an end cap 148. The end cap 148 may consist of two halves whichcan be attached together by various mechanisms such as snap fit,friction fit, corresponding engageable protrusions or by adhesives. Thesecond handle 12 mechanically engages with the end cap 148 therebypreventing axial/longitudinal movement between the respective two partsbut allows the second handle 12 to rotate independently from the end cap148. In one example, as shown in FIG. 12, one or more protrusions 160,such as a collar, thread or ring on the inner surface 140 of the secondhandle 12 may be engageable with a correspondingly shaped collar,protrusion, thread or ring on the end cap 148.

The inner surface 140 of the second handle 12 may further comprise oneor more structures, which engage with a mechanism such as a nut 142. Aspreviously mentioned, the nut 142 is located within the second handle 12as shown generally in FIG. 13, where a portion of the second handle 12has been removed to show the nut 142 in the interior of the secondhandle 12. In one non-limiting example, as shown in FIG. 12, the secondhandle 12 may comprise an opening or aperture 144 which engages with oneor more radial protrusions 146 on the nut 142 (also see FIGS. 22, 24 and31-33). As such, at least a portion of the inner surface 140 of thesecond handle 12 is engaged or otherwise operatively connected with thenut 142. One of skill in the art would recognize that any similarmechanisms or structures that allow the second handle 12 to engage withthe nut 142 may be used. As shown in FIGS. 15 and 16, the nut 142 may bea cylindrical or tubular structure that completely encircles a portionof the main handle 10, or the nut 142 may partially cover or surroundthe main handle 10.

In one example, the nut 142 may be a solid structure, or as shown inFIGS. 16, 31 and 33, a distal end 149 may be a solid structure or ringwhich encircles a portion of the main handle 10 while a proximal end 150of the nut 142 may comprise a series of adjacent panels, fingers orflanges that extend proximally from the distal end 149 of the nut 142.The nut 142 may be constructed from a resilient material, includingplastics, rubbers, metals, polymers, or a combination thereof. As shownin FIG. 16, the nut is constructed of a resilient material and includesone or more shimstocks 151 that are integrally formed with the nut oralternatively, the shimstocks 151 are separate components that arefitted within a correspondingly shaped channel formed in the nut andthen secured to the nut, such as by adhesives or other acceptableattachment mechanisms. The shimstocks 151 are essentially a thinstainless steel flat wire with thickness of about 0.003-0.010 inches mayserve as a “skeleton” to the nut.

As will be described in further detail below, the proximal end 150 ofthe nut 142, including the series of fingers or flanges, may flareradially outwardly in a neutral or relaxed state. (See FIG. 16 and FIG.33, for example). The proximal end of the nut has a second radiallyinwardly compressed state, such that the inner surface of the nut 142 isconfigured to engage with an outer surface 122 of the main handle 10.(See FIG. 31, for example.) The shimstocks 151 help to preserve theshape of the nut and maintain the resiliency of the nut, to help ensurethat the proximal end of the nut can move from the inwardly compressedstate to the radially outwardly flared state. In one non-limitingexample, the shimstocks 151 help to safeguard from the effect of ageingof plastic or other resilient materials from which the nut 142 may beconstructed by preserving resiliency and the tendency for the nut 142 toflare radially outwardly. If the nut loses its elasticity or resiliency,the internal threads on the nut 142 may not fully separate or disengagefrom the external threads 132 of main handle 10. The shimstocks 151facilitate disengagement of the nut 142 from the main handle 10 whennecessary or desired as described in detail below.

The second handle 12 may be rotated to move it from its first proximalmost position on the main handle 10 (as shown in FIGS. 1, 8 and 15) tovarious intermediate positions (such as in FIGS. 14, 21 and 22, forexample) located between the proximal and distal ends 136, 138 of thelongitudinal slot 134 formed in the main handle 10. Distal movement ofthe second handle 12 relative to the main handle 10 requires rotation ofthe second handle 12 when the inner surface 152 of the nut 142 withinthe second handle 12 is threadedly engaged with the outer surface 122 ofthe main handle 10. In other words, this threaded engagementnecessitates rotation of the second handle 12 to impart longitudinalmovement of the second handle 12 relative to the main handle 10.Rotation of the second handle 12 may be desired so as to provide morecontrol and accuracy to the sheath retraction and stent graft placementand deployment (as shown in FIGS. 40 and 41, for example).

FIGS. 13 and 15 are perspective views of the handle assembly 8 shownwith a portion of the second handle 12 removed, showing the secondhandle 12 in a proximal most position on the main handle 10. A ratchetedcollar 154 is positioned under the second handle 12. The ratchetedcollar 154 may fully or partially surround the main handle 10. As shownin FIG. 15, the ratcheted collar 154 extends distally from the grippingportion 126 of the main handle 10. The ratcheted collar 154 may bemolded from a single unitary piece of material or may be multipleseparately molded pieces (i.e., a collar portion 154 a and a ratchetportion 154 b) which are attached together such as by welding or glue.The ratcheted collar 154 may have one or more protrusions or teeth 156that allow only for unidirectional rotation of the second handle 12. Forexample, one or more protrusions formed on the inner surface 140 of thesecond handle 12, or, alternatively a shim 158 positioned in a slot onthe inner surface 140 of the second handle 12, as shown in FIG. 12,engage with the ratcheted collar 154, so that the second handle 12 canrotate about the main handle 10 in one direction, while rotation of thesecond handle 12 about the main handle 10 in the opposite direction isprevented.

The ratcheted collar 154 is preferably shaped so that it does not rotaterelative to the main handle 10, but which allows the ratcheted collar154 to slide longitudinally relative to the main handle 10. For example,the cross-sectional shape of the ratcheted collar 154 may be oblong orpolygonal, have one or more flat sides or be irregularly shaped so thatrotation of ratcheted collar 154 is prevented when the second handle 12is rotated about the main handle 10, but which allows the ratchetedcollar 154 to move longitudinally along the main handle 10 as the secondhandle 12 is moved distally by the user. It will be appreciated that thecomponents of the handle assembly 8, including the second handle 12, maybe designed to rotate in any particular direction, however, as describedherein for exemplary purposes, the ratcheted collar 154 is configured topermit clockwise rotation of the second handle 12 and preventcounter-clockwise rotation.

Before use of the delivery device 2 and when the delivery device istracked to a desired location within a patient's body, the second handle12 is disposed in a first or proximal-most position on the main handle10 and the stent graft 42 at the proximal end 4 of the delivery device 2is fully sheathed and held in a radially inwardly contracted conditionas shown in FIGS. 1, 2 and 34. More specifically, with the stent graft42 fully sheathed, the series of stents 50 on the main tubular body 62as well as the stents 72 on the side arm 58 are held in a radiallyinwardly contracted condition. As the second handle 12 is rotated tomove it distally along the main handle 10, the protrusion 160 (such as acollar or ring on the inner surface 140 of the second handle 12) engageswith a protrusion on the end cap 148 as shown in FIGS. 12 and 26. Asmentioned above, the second handle 12 can rotate freely andindependently of the end cap 148. The longitudinal slot 134 formed inthe main handle 10 accommodates the sheath flush port 116 on the sheathconnector 108, such that as the second handle 12 is moved distallyrelative to the main handle 10, the sheath flush port 116 can slidedistally along with the sheath connector 108 and the second handle 12through this longitudinal slot 134 formed in the main handle 10 as showngenerally in FIG. 14.

As the second handle 12 rotates and moves distally along the main handle10, the end cap 148 is pushed distally, which in turn pushes the sheathconnector 108 distally, thereby also pulling the sheath 104 distally, toexpose a proximal end 44 of the stent graft 42. Further retraction ofthe second handle 12 may also facilitate the retraction of the triggerwires as well as expose the distal end 48 of the stent graft 42, as willbe described further below. In other words, when the second handle 12 isin the proximal most position on the main handle 10 as shown in FIGS. 1,2 and 8, the stent graft 42 is fully covered by the retractable sheath104 at the stent graft retention region 16 of the device 2, and thetrigger wires retain the stent graft 42 in a radially-inwardlyconstrained delivery configuration against the inner cannula 22. Thetrigger wires cannot be retracted in order to release the stent graft 42from a radially inwardly constrained delivery configuration until anappropriate stage of deployment (i.e., after the second handle 12 hasbeen retracted distally for a pre-determined distance, therebywithdrawing the sheath 104 a sufficient distance to expose at least theproximal end of the stent graft and the side arm 58).

As depicted generally in FIGS. 17, 18 and 25, a catheter hub 174 isdisposed at least partially within the end cap 14 at the distal end 120of the main handle 10. The back end cap 14 may be a single structure ormultiple parts or halves snap-fitted together and into engagement withthe distal end 120 of the main handle 10. End cap 14 may have a distaltaper 176 and may be removable or split open by the user should the needarise, such as in an emergency “bailout” procedure in the event that oneor more components of the handle assembly 8 fail during deployment, thusallowing the user to remove the end cap 14 and access the handleinterior 124, to manually perform certain deployment steps described infurther detail below. The inner cannula 22 extends distally through theback end cap 14 to the distal flush hub 24, as can be seen in FIG. 17.

With reference to FIGS. 17 and 25, the catheter hub 174 is disposedcircumferentially around the inner cannula 22, and secured in place,such as by the pin vise 178, although other suitable mechanisms forattaching the inner cannula 22 to the catheter hub 174 are alsocontemplated, including adhesives, welding and the like, for example. Asshown in detail in FIG. 18, the catheter hub 174 has a proximal end 162and a distal end 164, an outer surface 166 and a lumen 168 extendingbetween the proximal and distal ends. The proximal end 162 of thecatheter hub 174 has outer threads 170 that are configured to mate withcorrespondingly shaped threads (not shown) formed within the stationarycollar 36. The distal end 164 of the catheter hub 174 comprises innerthreads 172 that are configured to mate with correspondingly shapedthreads (not shown) formed on the pin vice 178. As such, the pin vice178 can be inserted into and secured to the distal end 164 of thecatheter hub 174, thereby attaching the catheter hub 174 and the innercannula 22.

As shown in FIG. 18, a channel or groove 180 extends proximally from thedistal end 164 along a portion of the outer surface 166 of the catheterhub 174. About one-third to one-half the distance from the distal end164 of the catheter hub 174, the channel 180 that is formed in the outersurface 166 of the catheter hub 174 angles or slants downwardly andtowards the lumen 168 of the catheter hub 174 and intersects with thelumen. As will be discussed in greater detail below, a catheter 182having a proximal end 184 a distal end 186 and a lumen extending therebetween extends along the groove 180 formed in the outer surface 166 ofthe catheter hub 174, through the lumen 168 of the catheter hub 174 andproximally through the lumen of the positioner 30. The catheter 182exits from the lumen of the positioner 30 at the proximal end 32 of thepositioner (where the proximal end 32 of the positioner is located justdistal to the distal end 48 of the stent graft 42) and the catheter 182further extends along the outer surface of the nose cone dilator 18. Theproximal end 184 of the catheter 182 extends through and within one ormore grooves 188 formed in the nose cone dilator 18.

The groove 188 fainted in the nose cone dilator 18 may be a longitudinalgroove, or it may comprise other configurations, such as that shown inFIGS. 5, 6, 19 and 20 where the groove 188 in the nose cone dilator 18is substantially straight near the distal end 82 of the nose conedilator 18 and then curves around substantially perpendicularly to thelongitudinal axis. The catheter 182 extends through the groove 188formed in the nose cone dilator 18 and conforms to the shape andconfiguration of the groove 188. As shown in FIGS. 19 and 20, theproximal end 184 of the catheter 182 lies substantially straight alongthe straight longitudinal portion at the distal end of the groove 188and the catheter 182 then bends to conform to the bend or curve in theproximal portion of the groove 188. As FIGS. 20 and 38 show, the lumenof the catheter 182 is sized to accommodate a guide wire 190 therethrough.

With the sheath 104 retracted to expose the proximal end 44 of the stentgraft 42, the user may continue to rotate the second handle 12 tofurther move the second handle 12 distally along the main handle 10,thus further retracting the sheath 104 and exposing more of the mainbody 62 of the stent graft 42 (and, depending on the length and locationof the side arm 58 on the main body 62) also expose at least a portionof the side arm 58 as shown in FIG. 41. In cases where the side arm 58is relatively short as shown in FIG. 4, the second handle 12 may onlyneed to be moved distally a relatively short distance along the mainhandle 10 to fully expose the side arm 58. On the other hand, in caseswhere the side arm 58 is relatively longer (as shown in FIG. 3) thesecond handle 12 must be moved further distally on the main handle 10 inorder to fully un-sheath and expose the side arm 58.

The second handle 12 may continue to move distally until the distal end14 of the sheath connector 108 within the second handle 12 and/or theend cap 148 touches, meets, abuts or is otherwise adjacent to a triggerwire release mechanism 204 located within the main handle interior 124,as shown in FIGS. 21 and 27. The user may feel a slight resistance whichsignals that the sheath connector 108 has reached the trigger wirerelease mechanism 204. Other visual or mechanical signals may also bepresent on the delivery device 2 and/or handle assembly 8 to indicate tothe user to stop rotating the second handle 12 (to thereby stop furtherdistal movement of the second handle 12 along the main handle 10)including visual cues provided by desired imaging modality (i.e., byfluoroscopy, MRI, 3D or other imaging techniques). At this point, in onenon-limiting example, distal movement of the second handle 12 relativeto the main handle 10 has moved the sheath connector 108 distally,thereby retracting the sheath 104 a sufficient travel distance 206 suchthat the proximal end 44 of the stent graft 42 and at least a portion ofthe side arm 58 has been exposed. The distal end of the stent graft 42,however, may still be sheathed, as shown in FIG. 41.

At this stage, the user may continue to move the second handle 12distally to a final or distal-most position on the main handle 10 asshown in FIGS. 23 and 24 to further retract the sheath 104 and exposethe distal end 48 of the stent graft 42, while and simultaneouslyreleasing of the proximal trigger wires 84, 90 as well as any additionalattachment mechanisms, including one or more distal trigger wires 208that may be in place to releasably couple the distal end of the stentgraft 42 from the inner cannula 22.

This final distal movement of the second handle 12 to a position on themain handle 10 as shown in FIGS. 23 and 24 may be accomplished by theuser continuing to rotate the second handle 12 relative to the mainhandle 10 as described above, where rotation of the second handle 12causes the second handle 12 to travel distally in a longitudinaldirection along the main handle 10. Alternatively, rather thancontinuing to rotate the second handle 12 to move it distally, the userhas the option to implement a “quick release” protocol in order toretract the second handle 12 distally without rotation, as will bedescribed in further detail below.

The distance of travel of the second handle 12 relative to the mainhandle 10 to this final or distal-most position is identified asreference number 210 in FIGS. 23 and 24. In other words, distal movementof the second handle 12 from an intermediate position in FIGS. 21 and 22to the distal most position in FIGS. 23 and 24 causes the sheathconnector 108 to retract distally (thereby retracting the sheath 104distally) to expose the distal end 48 of the stent graft 42. At the sametime, the distal end or end cap 148 of the second handle 12 and/or thedistal end 114 of the sheath connector pushes against the trigger wirerelease mechanism or knob 204 located within the main handle 10 as shownin FIG. 27. As shown in FIGS. 25 and 26 and described above, the triggerwire release mechanism 204 is a ring that is slidably disposed over thepositioner 30. One or more distal trigger wire(s) 208 extend proximallyfrom the trigger wire release mechanism 204 to the distal end of thestent-graft 48 as described further below and shown in FIGS. 26 and28-30. The distal trigger wire(s) 208 have a proximal end 200 and adistal end 202. The distal end 202 of the distal trigger wire 208 may besecured to, connected or otherwise attached to the trigger wire releasemechanism 204 as shown in FIG. 25.

In one example, the positioner 30 provides a conduit for the proximaltrigger wires 84, 90 and/or the distal trigger wire(s) 208 to extendfrom the trigger wire release mechanism 204 in the main handle 10 to theproximal end and distal end 44, 48, respectively of the stent graft 42.As shown in FIG. 26, the distal end 202 of trigger wire 208, along withthe distal ends 88 of the proximal trigger wires 84, 90 may be securedto the trigger wire release mechanism 204 by one or more set screws 214,although other attachment mechanisms may be used including adhesives,welding, crimping or a combination thereof. The proximal trigger wires84, 90 and the distal trigger wire 208 then extends proximally from thetrigger wire release mechanism 204 and run along the outer surface 31 ofthe positioner 30. A coil or spring 96 that is coaxial with and extendsaround and along the outer surface 31 of the positioner 30 retains thetrigger wires 84, 90, 208 against the outer surface 31 and provides aconduit through which the trigger wires 84, 90, 208 can extend. In otherwords, the proximal trigger wires 84, 90 and the distal trigger wire 208are held between the outer surface 31 of the positioner and the innersurface of the coil 96.

As FIG. 26 shows, the coil 96 has a proximal end 98 that is adjacent toand/or abuts the distal end cap 148 of the outer rotating handle 12and/or the distal end 114 of the sheath connector 108. A distal end 100of the coil 96 is adjacent to and/or abuts the trigger wire releasemechanism 204. The coil 96 may be constructed of various resilientmaterials, for example, stainless steel or other metals or alloys,plastics, rubbers and/or polymers, and in one example, the coil 96 isconstructed of nylon. The coil 96 may be biased in an expanded position.As shown in FIG. 26, the proximal trigger wires 84, 90 and the distaltrigger wire 208 extends proximally beyond the proximal end 98 of thecoil 96 and into the end cap 148 of handle 12. Within the back end cap148 is a hemostatic valve 94 or seal, such as an “O” ring or siliconedisc to maintain hemostasis within the main handle 10 and to preventleakage or back flow of fluids around the positioner 30, or in otherwords, prevents leakage between the outer diameter of the positioner 30and the sheath connector 108. The trigger wires 84, 90, 208 extendthrough the hemostatic valve 94 and enter into the positioner 30 throughone or more openings, holes or apertures 216 formed in the positioner 30as shown in FIG. 26. The trigger wires 84, 90 and 208 further extendproximally through the conduit provided by the lumen of the positioner30 to the stent graft 42.

The distal trigger wire(s) 208 may be directly or indirectly attached tothe distal end 48 of the stent graft 42. For example, the distal triggerwire 208 may engage a suture loop 209 which is attached to the distalend 48 of the stent graft 42 as shown in FIG. 28. Alternatively, thedistal trigger wire 208 may be woven directly through or removablyattached to the graft material 52 or may be woven around or over one ormore stents 50 at the distal end of the graft 42 as shown in FIGS. 29and 30. Other suitable attachment methods or mechanisms may be used toremovably attach the distal trigger wire 208 to the distal end of thestent graft 42 as would be recognized by one of skill in the art.

As FIGS. 21-24 illustrate, distal movement of the second handle 12pushes or drives the trigger wire release mechanism 204 distally withit, thereby pulling the one or more distal trigger wires 208 in a distaldirection. More specifically, as the second handle 12 is moved distallyalong the main handle 10, the coil 96 becomes compressed as seen in FIG.27. When the coil 96 has become completely compressed, it serves as aspacer between the distal end 114 of the sheath connector 108 (and/orthe distal end cap 148 of handle 12) and the proximal facing surface ofthe trigger wire release mechanism 204. At this stage, as the outerhandle 12 continues to move distally backwards by the user, the distalend 100 of the coil 96 will simultaneously push distally backwards onthe trigger wire release mechanism 204. As the trigger wire releasemechanism 204 is pushed distally backwards, the proximal ends 86 of theproximal trigger wires 84, 90 and the proximal end 200 of the distaltrigger wire 208 will be retracted and released from the respectiveproximal end 44 and distal end 48 of the stent graft 42 (i.e., theproximal and distal trigger wires 84, 90, 208 are retracted and releasedfrom the stent graft 42, such as by becoming disengaged from the graftmaterial 52, disengaged from the suture loop 209 and/or disengaged fromone or more stents 50 of the stent graft). Distal movement of the secondhandle 12 ceases upon second handle 12 reaching the distal end 138 ofthe longitudinal slot 134 formed in the main handle 10 and/or when thetrigger wire release mechanism 204 abuts or contacts the stationarycollar 36 at the distal end 120 of the main handle 10 as shown in FIGS.23 and 24.

The steps of a quick release procedure are now generally described. Asset forth above, second handle 12 can rotate about the longitudinal axisof the main handle 10 to move the second handle 12 distally to anintermediate position on the main handle, such as that shown in FIG. 21,thus retracting the sheath 104 to expose the proximal end 44 of thestent graft 42, the main body 62 and the side arm 58 as shown in FIG.41. The threaded engagement between the inner surface 152 of the nut 142and outer surface 122 of the main handle 10 necessitates rotation toimpart longitudinal movement of the second handle 12 relative to themain handle 10. The user may continue to rotate the second handle 12 tomove it distally to further retract the sheath 104 to expose the distalend 48 of the stent graft 42 and release the trigger wires 84, 90 fromthe proximal end 44 of the stent graft and release the trigger wire 208from the distal end 48 of the stent graft 42 during deployment. However,as an alternative, the quick release procedure may be employed at thisstage of deployment, if desired, in order to further retract the sheath104 to expose the distal end of the stent graft 42 and to simultaneouslyrelease the trigger wires 84, 90, 208 without having to rotate thesecond handle 12 relative to the main handle 10.

More specifically, instead of rotating the second handle 12 to move itdistally relative to the main handle 10, the quick release procedureprovides the user the ability to slide the second handle 12 freely alongthe main handle 10 in a straight pull-back motion, so that the secondhandle 12 can simply slide longitudinally along the main handle 10 in acontinuous smooth non-rotating motion. This provides several advantages,including, for example, the user being able to retract the second handle12 more quickly and without rotation to complete sheath retraction andtrigger wire removal. It also facilitates a final stage of a deploymentprocedure once the entire stent graft 42 is deployed, allowing the userto re-sheath or recapture at least a portion of the nose cone dilator 18within the sheath 104 for removal of the device 2 from a patient's bodyas shown in FIG. 51 and described in further detail below.

In the first steps of the quick release procedure, the user can firmlygrip the gripping portion 126 of the main handle 10 with one hand whilepulling back on an outer handle or ring 220 located on the second handle12 with the other hand as FIG. 21 shows to “release” or disengage thesecond handle 12 from the main handle 10, thus allowing the secondhandle 12 to slide freely along the main handle 10 without rotation in astraight pull-back motion.

More specifically, as shown in FIGS. 31 and 33, the nut 142 locatedwithin the second handle 12 extends at least partially circumferentiallyaround at least a portion of the main handle 10. As shown in one examplein FIG. 31, the inner surface of the nut 142 is engaged with threads 132on the outer surface 122 of the main handle 10 by a threaded engagement,although other mechanisms may be used to provide engagement between thenut 142 and the main handle 10. With the inner surface 152 of the nut142 engaged with the outer surface 122 of the main handle 10, the secondhandle 12 must be rotated in order to move the second handle 12 distallyalong the main handle 10 (such as during the previously-described stepsof moving the second handle 12 distally to facilitate sheath retractionand proximal stent deployment.)

As shown in FIGS. 31 and 32, a sleeve 222 extends at least partiallycircumferentially over and/or around the nut 142, or alternatively, thesleeve 222 may completely surround or enclose a portion of the outersurface of the nut 142. In one non-limiting example, the sleeve 222 maybe a curved, arcuate and/or semi-circular structure that is positionedabout the outer surface of the nut 142, as shown in FIG. 32. The outersurface of the sleeve 222 may have one or more radially outwardlyextending protrusions 224 that extend through one or more openings orslots 226 formed in the second handle 12 (see FIG. 12) so as to engagewith an opening or channel formed in the inner surface of the outerhandle or ring 220. Any other suitable mechanisms and/or correspondinglyshaped structures on the sleeve 222 that are configured to allow thesleeve 222 to connect to or operatively engage with the outer handle orring 220 may also be used as would be recognized by one of skill in theart.

When the ring 220 is in a first or proximal position relative to thesecond handle 12 as shown in FIG. 31, the sleeve 222, which isoperatively engaged with the outer handle or ring 220 as previouslydescribed, is also positioned at a proximal end 150 of the nut 142. Thesleeve 222 holds the proximal end 150 of the nut 142 in a radiallyinwardly compressed condition and prevents such outward flaring of thenut 142. Thus, the sleeve 222 maintains and/or urges the nut 142radially inwardly and urges the threads on the inner surface 152 of thenut 142 into engagement with the outer surface 122 of the main handle10. Thus, when the ring 220 is in this first or proximal position on thesecond handle 12 (FIG. 31), the nut 142 is engaged with the main handle10 such that the second handle 12 must be rotated to move the secondhandle 12 longitudinally in a distal direction.

However, during quick release, the ring 220 is moved from the firstproximal position to a second distal position (see FIG. 33) by the userto move the sleeve 222 distally relative to the nut 142. As shown inFIG. 33, when the sleeve 222 is moved distally, the proximal end 150 ofthe nut 142 is permitted to expand radially outwardly or flare so thatthe inner surface 152 of the nut 142 is released from engagement withthe main handle 10. In one example, the nut 142 is self-expanding, suchthat when the sleeve 222 is moved distally, the proximal end 150 of thenut 142 may expand radially outwardly without the aid or assistance ofmechanical expansion techniques because the proximal end 150 of the nut142 may have a tendency to flare radially outwardly in a natural orrelaxed position. Shimstocks 151 may, if present, help facilitate suchoutward flaring to ensure that the nut 142 disengages from the mainhandle 10.

However, in another example, the nut 142 may also be mechanicallyexpanded. In particular, as shown in FIG. 32, the proximal portion 228of the sleeve 222 includes an expanding structure 230 that is configuredto engage with at least a portion of the inner surface 152 of the nut142 and urge the proximal end 150 of the nut 142 radially outwardly.Thus, as the sleeve 222 is moved distally, the expanding structure 230comes into contact with the proximal end 150 of the nut 142 to radiallyoutwardly expand the proximal end 150 of the nut 142. The inner surface152 of the nut 142 thus becomes disengaged from the main handle 10allowing the second handle 12 to be moved distally along the main handle10 in a straight pull-back motion without rotation.

The expanding structure 230 may be in the form of a ring, partial ring,semi-circle, wedge and/or any other structure that facilitates radialexpansion of the nut 142. As shown in FIGS. 31-33, the expandingstructure 230 is a semi-circular structure that is located just proximalto and connected to the sleeve 222. The expanding structure 230 has aradius that is smaller than the radius of the sleeve 222. When the ring220 is pulled distally back, the sleeve 222 with the expanding structure230 also moves distally back. The expanding structure 230 drives itselfbetween the outer surface 122 of the main handle 10 and the innersurface 152 of the proximal end 150 of the nut 142, thus urging theproximal end 150 of the nut 142 in a radially outwardly expandedcondition. Thus, even if the nut 142 is self-expanding but somehow failsto self-expand upon movement of the ring 220 (and simultaneously, thesleeve 222) to a distal position, then the expanding structure 230 willfacilitate the radially outward expansion of the proximal end 150 of thenut 142 to disengage the nut 142 from the main handle 10, allowing thequick release procedure to still be utilized. A self-expanding nut 142may fail to sufficiently expand or become deformed so that it cannotfully disengage from the main handle 10 because of age and/orsterilization, for example. Alternatively, if the nut 142 is notself-expanding and is dependent on mechanical expansion, the expandingstructure 230 serves to facilitate the radially outward expansion of theproximal end 150 of the nut 142 during the quick release procedure.

The action of sliding outer ring 220 distally preferably also makesvisible an arrow (or set of arrows or other similar markings) on thesecond handle 12 as shown in FIG. 21, which serve as an indicator to theuser that the second handle 12 is ready for quick release by straightdistal pull-back of the second handle relative to the main handle 10. Atthis time, with the proximal end 150 of the nut 142 flared radiallyoutwardly as shown in FIG. 33, the second handle 12 is disengaged fromthe main handle 10 and can be slid distally towards the user in astraight pull-back motion (without rotation) so that further retractionof the sheath 104 to expose the distal end 48 of the stent graft 42 canbe completed while simultaneously withdrawing the proximal and distaltrigger wire(s) 84, 90, 208 to fully release the stent graft in thevasculature as shown in FIG. 48, thus accomplishing a quick releaseportion of the deployment procedure.

The operation of the delivery device 2, and in particular, onenon-limiting example of a deployment sequence using the handle assembly8 of the delivery device 2, will be described in reference to FIGS.34-49. In this example, use of the delivery device 2 will be describedin reference to the implantation of a stent graft 42 in one or moreiliac arteries extending distally from the aorta 354 of a patient. Afteran incision is made in the femoral artery of the patient, the nose conedilator 18 is inserted into the incision and the device 2 is trackedover a guide wire 28 and advanced through the ipsilateral external iliacartery 352 and common iliac artery 350 to the desired location forplacement of the stent graft 42 at the site of an aneurysm 348 as shownin FIG. 34. The outer sheath 104 is disposed over the stent graft 42 andextends distally up to at least the distal end 82 of the nose conedilator 18 during insertion and delivery to the target site, as shown inFIG. 34. As shown in detail in FIG. 35 and FIG. 36, the proximal end 184of catheter 182 can be seen extending out of the proximal end of thesheath 104. A guide wire 190 extends through the lumen of the catheter182.

Upon proper positioning at the target site using a desired imagingmodality (i.e., by fluoroscopy, MRI, 3D or other imaging techniques) theguide wire 190 can be extended proximally through the pre-curvedproximal end 184 of catheter 182, allowing it to be grasped by a snare346 that has been extended proximally into the contralateral iliacartery 344. Once snared, the guide wire 190 can be pulled over theaortic bifurcation 342 and distally back down the contralateral iliacartery 344, as shown in FIGS. 37-39 to form a “through and through”guide wire 190.

As shown in FIG. 39, an access sheath 340 can be advanced over thethrough and through guide wire 190 until it is above the level of theaortic bifurcation 342 and/or abuts the proximal end 184 of the catheter182. Using the desired imaging modality and one or more radiopaquemarkers (not shown) on the stent graft 42 and side arm 58, the user mayensure that the stent graft 42 is properly oriented such that the distalend of the side arm 58 is positioned above the origin of the internaliliac artery 338 to allow easy access into the internal iliac artery338.

When the position of the device 2 is satisfactory, the user maypartially withdraw sheath 104 as shown in FIG. 40. To withdraw thesheath 104, the user grasps the gripping portion 126 of the main handle10 with one hand, and using the other hand, grasps the second handle 12.The second handle 12 may be rotated relative to the main handle 10 tomove the second handle 12 distally along the main handle 10, therebyretracting the sheath 104 to expose at least a proximal portion of thestent graft 42. For example, the user may retract the sheath 104 toexpose the proximal end 44 and continue to withdraw the sheath 104 untilthe distal end of the side arm 58 is exposed as shown in FIG. 41. Atthis stage, the user stops withdrawing the sheath 104 and the secondhandle 12 may be located at an intermediate position on the main handle10, such as that shown in FIG. 21. It is noted that further sheathwithdrawal at this stage may expose the distal end 48 of the stent graft42 that extends into the external iliac artery 352, thus possiblylimiting further positional changes of the stent graft 42. The accesssheath 340 may be removed, such as by retracting it distally from thecontralateral iliac artery 344, leaving the through and through wire 190in place as shown in FIG. 41.

As shown in FIG. 42, an “up and over sheath” 336 can then be trackedproximally over the wire 190 through the contralateral iliac artery 344until the proximal tip 334 of the up and over sheath 336 comes intocontact with or abuts the pre-curved proximal end 184 of catheter 182.The user may continue to advance the up and over sheath 336 over thewire 190 so that the up and over sheath 336 advances over the aorticbifurcation 342 and into the proximal end 44 of the stent graft 42 andthrough the lumen of the side arm 58. Simultaneously, the catheter 182is pushed distally by the tracking of the up and over sheath 336 overthe wire 190. The up and over sheath 336 is tracked over the wire 190until the proximal tip 334 of the up and over sheath 336 is adjacent tothe distal end of the side arm 58 and/or extends distally out of theside arm 58 as shown in FIG. 43. The up and over sheath 336 can continueto be tracked over the wire 190 (while guide wire 190 extends distallyinto the proximal end 184 of the catheter 182 and through the lumen ofthe catheter 182 within the lumen of the sheath 104 as shown in anenlarged view in FIG. 45). At this stage, the user may wish to cannulatethe ipsilateral internal iliac artery 338 as further described below.

In one non-limiting example of cannulating the internal iliac artery338, the user may insert a secondary delivery assembly 332 through thelumen of the up and over sheath 336 as shown in FIGS. 44 and 45. Thesecondary delivery assembly 332 may comprise a delivery catheter 330having a guide wire 328 extending there through. As FIGS. 44 and 45show, the secondary delivery assembly 332 comprising the deliverycatheter 330 and guide wire 328 is further advanced through the up andover sheath 336 and into the opening of the internal iliac artery 338.With the delivery catheter 330 extending into the opening of theinternal iliac artery 338, the guide wire 328 may be replaced with astiffer wire, such as a Rosen or AES wire guide, if desired.

Next, as shown in FIGS. 46 and 47, the delivery catheter 330 may beremoved from the up and over sheath 336, leaving the up and over sheath336 and guide wire 328 in place. At this time, as shown in FIG. 47, asecondary stent graft 326 can be tracked over the guide wire 328 andextended into the internal iliac artery 338. The secondary stent graft326 may, in one non-limiting example, comprise a self-expanding stentgraft and/or a balloon-expandable stent graft sized and configured fordelivery and deployment in the internal iliac artery 338. The secondarystent graft 326 may be delivered to the internal iliac artery 338 in anumber of acceptable ways as would be understood by one of skill in theart, including but not limited to the secondary stent graft 326 beingpre-loaded onto an auxiliary delivery device (not shown) and/or retainedin a delivery configuration within a secondary sheath (not shown) tofacilitate introduction and delivery of the secondary stent graft 326over the guide wire 328 (and within the up and over sheath 336) to adesired location within the vasculature. A suitable combination of thesecondary stent graft 326 and an auxiliary delivery device (not shown)or a secondary sheath (not shown) may be selected such that theauxiliary delivery device (not shown) or a secondary sheath (not shown)can pass through the up and over sheath 336 in a co-axial manner whileallowing the through and through guide wire 190 to remain in place. Thesecondary stent graft 326 extends distally from the distal end of sidearm 58, thus serving as an extension of the side arm 58 and maintainingand/or restoring patency to the internal iliac artery 338.

At this stage, the sheath 104 may be retracted further distally toexpose the distal end 48 of the stent graft 42 as shown in FIG. 48.Further retraction of sheath 104 may be accomplished by again movingsecond handle 12 back in a distal direction relative to the main handle10 by the user to a position as shown in FIGS. 23 and 24 whilesimultaneously withdrawing the proximal trigger wires 84, 90 and thedistal trigger wires 208 to thereby deploy the stent graft 42 as shownin FIG. 48.

To accomplish this proximal and distal trigger wire removal anddeployment of the distal end 48 of the stent graft 42, the user maycontinue rotation of the second handle 12 or, alternatively, the usermay employ the quick release procedure as described above, which permitslongitudinal movement of the second handle 12 relative to the mainhandle 10 without having to rotate the second handle 12. Whether bycontinued rotation of the second handle 12 relative to the main handle10 or by implementation of the quick release procedure (allowingstraight pull-back of the second handle without rotation), the usermoves the second handle 12 distally along the main handle 10 for atravel distance indicated generally by reference number 212 in FIG. 21.In one non-limiting example, this travel distance 212 may be thedistance of longitudinal movement of the second handle 12 necessary tofacilitate distal retraction of the sheath 104 a sufficient distance toexpose the distal end 48 or the stent graft, such that the stent graft42 is completely un-sheathed. By this same action, the proximal anddistal trigger wire or wires 84, 90, 208 are also withdrawn from thestent graft 42 to complete the stent graft deployment. In the event of amechanical malfunction of one or more components of the handle assembly8 described above, the handle end cap 14 can be removed, and theinterior 124 of the main handle 10 can be accessed and manipulatedmanually to perform certain deployment steps such as allowing the userto manually pull back on the trigger wire release mechanism 204 torelease the trigger wires from the stent graft.

Once the stent graft 42 has been fully released from the delivery device2 as shown in FIG. 48, the up and over sheath 336 can be withdrawndistally to a suitable position to allow deployment of the secondarystent graft 326. As previously mentioned, the secondary stent graft 326may have self-expanding properties and/or it may be expanded bymechanical means, such as by balloon expansion.

Following deployment, and with the stent graft 42 released from thestent graft retention region 16 of the delivery device 2 as shown inFIG. 50 and the secondary stent graft 326 expanded within thevasculature as shown in FIG. 49, it may be desirable to withdraw thedelivery device 2 from the patient's body. In some instances, such as ifdelivery and deployment of an AAA main body stent graft for deploymentin the aorta 354 is desired, the guide wire 28 may be left in place evenafter the delivery device 2 is removed from the vasculature tofacilitate tracking of another delivery device (not shown) for thedelivery and deployment of an AAA main body stent graft.

When removing the delivery device 2 from the patient, if the quickrelease procedure described above has already been employed, then thenut 142 has already been disengaged or disassociated from the mainhandle 10, allowing the second handle 12 to slide freely longitudinallyalong the main handle 10. Thus, the user can slide the second handle 12in a proximal direction (away from the user) on the main handle 10, thussliding the sheath connector 108 and sheath 104 proximally and allowingthe proximal end of the sheath 104 to extend over all of, part of, or atleast distal portion 82 of the nose cone dilator 18 of the device 2 soas to “hub” or “recapture” a portion of the nose cone within the sheath104 as shown in FIG. 51.

Alternatively, rather than pushing the second handle 12 proximately tore-sheath the nose cone dilator 18, the main handle 10 may be pulleddistally relative to the second handle 12, thus pulling the distalportion 82 of the nose cone dilator 18 into the proximal end of thesheath 104. With at least a distal portion 82 of the nose cone dilator18 recaptured within the sheath 104, the delivery device 2 can bewithdrawn from the patient's body.

If, however, the user did not employ the quick release procedure fortrigger wire release (but instead the user decided to continue rotatingthe second handle 12 to move it distally relative to the main handle 10to accomplish these deployment steps), then, at this time, the secondhandle 12 is at a distal most position on the main handle (see FIGS. 23and 24) but the inner surface of the nut 142 is still threadedly engagedwith the outer surface 122 of the main handle 10. Thus, in order to movethe sheath 104 proximally for tip re-sheathing or recapture, the usermust first move the ring 220 distally on the second handle 12 to movethe sleeve 222 distally, allowing the proximal end 150 of the nut 142 toflare or expand radially outwardly and disengage from the threads 132 onthe main handle 10. This permits the second handle 12 to now slidefreely longitudinally on the main handle 10 and the user may then beable to move the second handle 12 proximally to recapture (re-sheath) atleast a distal portion 82 of the nose cone dilator 18 as previouslydescribed and shown in FIG. 51, and then remove the delivery device 2from the patient to complete the procedure, thus having effectively andefficiently deployed a stent graft 42 (and secondary stent graft 326)into one or more branched vessels, including, but not limited to acommon iliac artery and the external and internal iliac arteriesextending therefrom, in order to treat and/or restore patency to one orboth of such vessels.

Throughout this specification, unless the context requires otherwise,the words “comprise” and “include” and variations such as “comprising”and “including” will be understood to imply the inclusion of an item orgroup of items, but not the exclusion of any other item or group items.While various examples of the invention have been described, it will beapparent to those of ordinary skill in the art that many more examplesand implementations are possible within the scope of the invention.Furthermore, although various indications have been given as to thescope of this invention, the invention is not limited to any one ofthese but may reside in two or more of these combined together.Accordingly, the invention is not to be restricted except in light ofthe attached claims and their equivalents.

1. A handle assembly for a prosthesis delivery device comprising: astationary main handle that is fixed relative to the delivery devicecomprising a proximal end and a distal end; a second handle disposedover a portion of the main handle and rotationally moveable relative tothe stationary main handle; a sheath operatively connected to the secondhandle, the sheath extending proximally of the main handle, a triggerwire release mechanism operatively coupled to the second handle andcomprising at least one trigger wire attached thereto and extending fromthe trigger wire release mechanism to engage an end of a prosthesis;wherein rotation of the second handle relative to the stationary mainhandle both retracts the sheath distally and causes the trigger wirerelease mechanism to move distally to pull and release the at least onetrigger wire from the end the prosthesis.
 2. The handle assembly ofclaim 1, wherein a first rotation of the second handle retracts thesheath, and a second subsequent rotation of the second handle causes thetrigger wire release mechanism to move distally to pull and release theat least one trigger wire from the end of the prosthesis.
 3. The handleassembly of claim 1, wherein the rotation of the second handle causessimultaneous retraction of the sheath and release of the at least onetrigger wire from an end of the prosthesis.
 4. The handle assembly ofclaim 1, wherein the at least one trigger wire comprises first andsecond trigger wires coupled to the trigger wire release mechanism,wherein the first trigger wire is coupled to a proximal end of theprosthesis and the second trigger wire is coupled to a distal end of theprosthesis.
 5. The handle assembly of claim 1, further comprising asheath connector operatively coupled to the sheath and the secondhandle.
 6. The handle assembly of claim 5, wherein rotation of thesecond handle causes the sheath connector to move distally to retractthe sheath.
 7. The handle assembly of claim 1, wherein the stationarymain handle comprises a gripping portion and a threaded surface.
 8. Thehandle assembly of claim 7, wherein the second handle is disposed overand is operatively engaged with the threaded surface of the stationarymain handle.
 9. The handle assembly of claim 1 wherein retraction of thesheath in a distal direction exposes at least a proximal end of theprosthesis.
 10. The handle assembly of claim 9 wherein the at least onetrigger wire cannot be released from the prosthesis until the sheath hasbeen retracted to expose at least the proximal end of the prosthesis.11. The handle assembly of claim 1, wherein the trigger wire releasemechanism comprises a ring that is longitudinally slideable relative tothe main handle and wherein a distal end of the at least one triggerwire is attached to the ring.
 12. The handle assembly of claim 4,wherein the trigger wire release mechanism comprises a ring that islongitudinally slideable relative to the main handle and wherein adistal end of the first and second trigger wires are attached to thering.
 13. The handle assembly of claim 1, wherein an inner surface ofthe second handle comprises internal threads that are engageable withthe threaded surface of the main handle.
 14. A delivery system fordelivering a prosthesis, the delivery system comprising: a proximal endand a distal end; a prosthesis retention region at the proximal end ofthe delivery system; a prosthesis having a proximal end and a distalend, wherein the prosthesis is releasably coupled to the prosthesisretention region of the delivery system; a handle assembly disposed atthe distal end of the delivery system, wherein the handle assemblycomprises: a stationary main handle comprising a proximal end and adistal end and sidewall extending there between to define a main handlehousing interior; a second handle disposed at least partially over themain handle and rotationally moveable relative to the stationary mainhandle; a trigger wire release mechanism operatively coupled to thesecond handle and comprising at least one trigger wire attached theretoand extending from the trigger wire release mechanism to engage an endof the prosthesis, wherein rotation of the second handle relative to thestationary main handle causes the trigger wire release mechanism to movedistally and pull the at least one trigger wire from engagement with theend of the prosthesis; a sheath operatively connected to the secondhandle and extending proximally of the stationary main handle, thesheath having a first position wherein the prosthesis is covered by thesheath and a second position, and wherein rotation of the second handlerelative to the stationary main handle retracts the sheath in a distaldirection from the first position to the second position; and whereindistal movement of the trigger wire release mechanism is prevented whenthe sheath is in the first position.
 15. The delivery system of claim14, wherein a first rotation of the second handle retracts the sheath,and a second subsequent rotation of the second handle causes the triggerwire release mechanism to move distally to pull and release the at leastone trigger wire from the end of the prosthesis.
 16. The delivery systemof claim 14, wherein the rotation of the second handle causessimultaneous retraction of the sheath and release of the at least onetrigger wire from an end of the prosthesis.
 17. The handle assembly ofclaim 1, wherein the at least one trigger wire comprises first andsecond trigger wires coupled to the trigger wire release mechanism,wherein the first trigger wire is coupled to the proximal end of theprosthesis and the second trigger wire is coupled to the distal end ofthe prosthesis.
 18. The delivery system of claim 1, wherein thestationary main handle comprises a gripping portion and a threadedsurface.
 19. The delivery system of claim 18, wherein the second handleis disposed over and is operatively engaged with the threaded surface ofthe stationary main handle.
 20. The delivery system of claim 19, whereinthe trigger wire release mechanism comprises a ring that islongitudinally slideable relative to the main handle and wherein adistal end of the at least one trigger wire is attached to the ring. 21.The handle assembly of claim 1, wherein rotation of the handle isunidirectional.
 22. The delivery system of claim 14, wherein rotation ofthe handle is unidirectional.